Supplementary Material for: Preoperative Risk Factors for Residual Tricuspid Regurgitation after Isolated Left-Sided Valve Surgery: A Systematic Review and Meta-Analysis

Objectives: Residual tricuspid regurgitation (TR) that has developed after isolated left-sided valve surgery is not uncommon. Indications for concomitant tricuspid repair at the initial operation have not been well established. The selection of high-risk preoperative patients is of great importance in this situation. Methods: Six databases were searched to access eligible articles reporting potential risk factors for the development of residual TR. The pooled analysis of risk factors was based on odds ratios or mean differences with their 95% confidence intervals. Results: A total of 3,138 patients with 487 residual TR in 11 studies were analyzed. Of the 14 candidate parameters in our meta-analysis, 10 factors, i.e. older age, female gender, atrial fibrillation, rheumatic etiology, mitral valve surgery, previous valve surgery, a long time from onset to surgery, 2+/3+ TR and enlarged left and right atria, were found to be significantly associated with the development of residual TR. Conclusions: Our study highlights the role of the above preoperative risk factors in the development of residual TR after isolated left-sided valve surgery and emphasizes the need of further studies to investigate other potential predictors. Moreover, predictive models or scoring systems for the identification of patients at a high risk for developing late TR are urgently needed.

研究目标：孤立性左侧瓣膜手术后发生的残余三尖瓣反流(tricuspid regurgitation, TR)并非少见。初次手术同期行三尖瓣修复的指征尚未明确，在此类情境下，术前高危患者的筛选至关重要。研究方法：检索6个数据库，获取报道残余三尖瓣反流发生相关潜在危险因素的合格文献。危险因素的合并分析基于比值比或均差及其95%置信区间展开。研究结果：共纳入11项研究的3138例患者（其中487例发生残余三尖瓣反流）进行分析。本荟萃分析纳入14项候选参数，其中10项因素与残余三尖瓣反流的发生显著相关，包括高龄、女性性别、心房颤动、风湿性病因、二尖瓣手术、既往瓣膜手术、发病至手术间隔时间较长、2+/3级三尖瓣反流以及左右心房扩大。研究结论：本研究明确了上述术前危险因素在孤立性左侧瓣膜手术后残余三尖瓣反流发生中的作用，并强调需开展进一步研究以探索其他潜在预测因子。此外，亟需构建用于识别迟发性三尖瓣反流高危患者的预测模型或评分系统。